Written by Austin Ulrich, PharmD, BCACP | Reviewed by Joshua Murdock, PharmD, BCBBS Updated on June 1, 2023
Key takeaways:
- Some medications, like antidepressants and beta blockers, can cause vivid dreams and nightmares.
- Vivid dreams from medications are often caused by changes to chemicals in the brain. They can be bothersome, but are not typically dangerous to your health.
- If you’re having bothersome dreams, talk to your healthcare provider. They can help you manage these symptoms.
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Certain medications can affect your dreams — and not always in a good way. Vivid dreams and nightmares can be an unexpected side effect of several medications. And while they don’t happen to everyone, it’s helpful to be aware of some of the most common offenders.
1. Metoprolol and other beta blockers
Beta blockers are some of the most common medications associated with disturbed dreaming. In fact, one study found that about one-third of people who had nightmares were taking a beta blocker.
Beta blockers treat high blood pressure and other heart-related conditions. But they also block the release of melatonin, a chemical made by the body to help regulate sleep. Less melatonin may contribute to sleeping problems, including insomnia and nightmares.
Some beta blockers may be more likely to cause nightmares. Examples include:
- Propranolol (Inderal LA, Innopran XL)
- Metoprolol (Lopressor, Toprol XL)
- Bisoprolol
- Nebivolol (Bystolic)
- Carvedilol (Coreg, Coreg CR)
If it’s safe for you to take, a melatonin supplement in the evening may help. Keep in mind that melatonin has side effects and can interact with other medications. So it’s best to check with your healthcare provider first.
Switching to a different beta blocker may also be an option. Your healthcare provider can help decide the best course of action.
2. Prozac and other antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are used for depression and other mental health conditions. They include antidepressants like:
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Citalopram (Celexa)
SSRIs make more serotonin available in the brain. While this may improve mood, it can also affect your sleep and have a strong effect on dreams.
Some SSRIs, like sertraline, can cause dreams to be more intense. And fluoxetine increases the chance that you’ll remember your nightmares. Certain SSRIs also suppress rapid eye movement (REM) sleep. This changes the body’s normal sleep cycle, which may contribute to nightmares.
But SSRIs aren’t the only antidepressants that may affect your dreams. Other examples include:
- Venlafaxine (Effexor, Effexor XR)
- Bupropion (Wellbutrin SR, Wellbutrin XL)
- Duloxetine (Cymbalta)
- Mirtazapine (Remeron, Remeron SolTab)
If these dreams are bothersome, talk to your healthcare provider. They may recommend the addition of another antidepressant — trazodone. It can help improve sleep quality when taken before bed. They may also decide to switch you to a different antidepressant altogether.
3. Antihistamines
Antihistamines are commonly used for allergies. First-generation antihistamines, like diphenhydramine (Benadryl, ZzzQuil) and doxylamine (Unisom SleepTabs), can make you sleepy. So they’re also present in many over-the-counter (OTC) sleep medications.
But one first-generation antihistamine in particular — chlorpheniramine (Chlor-Trimeton, Aller-Chlor) — can cause nightmares. This may be part of the reason it’s only found in OTC allergy medications and not typically used for sleep.
Medication-induced sleep terrors have also been reported with cetirizine (Zyrtec). Cetirizine is a second-generation antihistamine. These are less likely to affect your sleep, but cetirizine may cause more drowsiness than the other medications in this class.
If you experience troublesome dreams from an antihistamine, a different one may work better for you. Talk to your pharmacist or healthcare provider about an alternate option.
4. Sleep aids: Ambien, melatonin, and other Z-drugs
Some medications used to treat insomnia can also cause nightmares. While this side effect doesn’t happen to everyone, it’s good to know about.
Z-drugs
Z-drugs are common medications prescribed for sleep. Examples include:
- Lunesta (eszopiclone)
- Sonata (zaleplon)
- Ambien (zolpidem)
This class of medications — Ambien in particular — causes an increased risk of nightmares. Z-drugs may also cause hallucinations and sleep walking that you don’t remember after you wake up.
Melatonin and other OTC supplements
Melatonin is an OTC supplement often used for insomnia or jet lag. Your body naturally produces melatonin to help you sleep. In theory, taking more melatonin should help you sleep easier. But it can also cause nightmares.
Other OTC supplements can also cause vivid dreams. For example, valerian and ashwagandha are both used for anxiety and insomnia. These herbal supplements also have their own side effects and drug interactions you should know about before taking them.
A sleep medication that causes nightmares may not give you the restful night you want. So if these symptoms occur, talk to your healthcare provider about an alternate option.
5. Ozempic, Wegovy, and Rybelsus
Some people have reported vivid or abnormal dreams while taking semaglutide. This is the active ingredient in Ozempic and Rybelsus, medications for Type 2 diabetes. It’s also the active ingredient in Wegovy, a form of semaglutide approved for weight loss.
It’s not clear why this happens, or if it’s directly related to the medication itself, but it’s still good to be aware of.
6. Cipro and other antibiotics and antivirals
Certain medications that fight infections may cause nightmares as well. They can decrease proteins released by your body that help you sleep to better fight off an infection. This is thought to result in disturbed sleep and nightmares.
Some examples are:
- Ciprofloxacin (Cipro)
- Erythromycin (Ery-Tab, E.E.S.)
- Efavirenz (Sustiva)
- Mefloquine
7. Donepezil and other Alzheimer’s disease medications
Medications used to treat dementia may also affect sleep quality. Specifically, they can cause REM sleep behavior disorder (RBD). RBD can cause intense dreams — and sometimes the body acts out the dream while asleep. Examples include:
- Donepezil (Aricept, Adlarity)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
It’s recommended to take donepezil at night since it can make you dizzy. But a small study suggested that taking it in the morning may help with nightmares. Your healthcare provider may recommend this for you.
Keep in mind that dementia itself can also contribute to sleep troubles. So your healthcare provider may add another medication at night to help if nightmares become a problem.
8. Medications that affect dopamine
Several types of medications affect dopamine, a chemical in the brain. These types of medications can all cause vivid dreams or nightmares.
Parkinson’s disease medications
Parkinson’s disease is caused by decreased levels of dopamine in the brain. Medications that treat it increase dopamine levels, which can lead to nightmares. Examples include:
- Carbidopa/levodopa (Sinemet)
- Amantadine (Gocovri, Osmolex ER)
- Selegiline (Zelapar)
Antipsychotic medications
Medications that treat mental health conditions, like schizophrenia and bipolar disorder, also affect dopamine. Examples include:
- Clozapine (Clozaril)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
Stimulants
Some ADHD (attention-deficit hyperactivity disorder) medications can also cause vivid dreams. This is likely because they increase dopamine levels. Examples include:
- Methylphenidate (Ritalin, Methylin)
- Dextroamphetamine/amphetamine salts (Adderall)
If any of these medications give you unpleasant dreams, your healthcare provider can help you manage them. They may change your dose or try a different medication in the same class. They could also suggest adding another medication at night to help you sleep easier.
9. Atorvastatin and other statins
Statins are a first-choice treatment for high cholesterol. Nightmares and sleep disturbances have been reported in some people taking statins. But a review of the few available studies did not find a clear link between the two.
It seems that if statins do cause nightmares, it’s a rare side effect. But if you notice a change in your dreams, speak to your healthcare provider. They may have you try a different statin or switch to another medication to manage your cholesterol.
10. Chantix
Chantix (varenicline) is a first-choice medication for helping people quit smoking. It affects your brain in a similar way to nicotine, but it doesn’t contain any nicotine.
Vivid or abnormal dreams are a common side effect of Chantix. They occur in more than 1 in 20 people who take the medication. It’s also one of the reasons people stop taking it.
You’ll usually only take Chantix for a few months, so as long as the dreams aren’t troubling you, they’ll go away after you stop taking it. But if they’re a problem, talk to your healthcare provider about other options to quit smoking.
How do medications cause nightmares?
It’s not completely understood how medications cause nightmares. Often, the medications that can cause nightmares are known to affect the brain. They may change the levels of chemicals like serotonin and dopamine. Or they may have a direct effect on your sleep cycle.
Medication-induced nightmares vary from person to person. Other factors, like mental health disorders or another underlying health condition, may also influence your dreams. So medication may not always be to blame.
When should I contact my healthcare provider if I experience vivid dreams?
If you experience vivid dreams that are bothersome, contact your healthcare provider. They can help determine whether these dreams may be caused by your medication. They can also help you manage your symptoms.
Remember that you shouldn’t stop taking medication on your own. In some cases, that may actually make your dream-related side effects worse.
The bottom line
Some medications, like antidepressants and beta blockers, can cause nightmares and vivid dreams. While dreams can be disturbing, they usually don’t impact your health. But if they’re bothersome, talk to your healthcare provider. They can help determine whether your dreams are caused by medication and suggest the best way to manage them.
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